Cardiac rehabilitation is profoundly effective at improving physical activity and reducing morbidity and mortality of heart patients. Despite its effectiveness, it is highly underutilized. Research indicates proxy-efficacy and self efficacy positively correlate and predict exercise adherence after Phase II cardiac rehabilitation (Bray & Cowan, 2004; Bray, Brawley, & Millen, 2006). The purpose of the current study aims to investigate the relationship of Phase I patients' proxy-efficacy and self efficacy and their intention to enroll in Phase II cardiac rehabilitation. Thirty participants completed measurements of self-efficacy and proxy-efficacy, a demographic questionnaire, and asked to indicate intent to enroll. Results revealed proxy-efficacy does not predict intention to enroll into Phase II cardiac rehabilitation. Even though patients generally had high confidence in their cardiac rehabilitation specialists, proxy-efficacy was an insufficient predictor of intention to enroll in subsequent cardiac rehabilitation services. Moreover, results indicate proxy-efficacy and self efficacy for exercise are not related. / School of Physical Education, Sport, and Exercise Science

As the development of medical treatments and the increase in longevity of human life interface with the rising cost of medical care, the issue of quality of life appears to be coming to the forefront in understanding how health care decisions will best be realized for patients. Ethical questions relating to matters such as cost-effective economics, physician-assisted suicide, and quantity of life versus quality of life make the construct of quality of life even more important to ascertain.Quality of life can be an elusive construct to define as well as a difficult one to measure; however, recent literature has shown promising trends. Many quality-of-life measures have been developed in recent years. Initially these measures focused on life satisfaction in general. Then instruments for healthrelated concerns were developed. In the last decade such measures have become more specific as several have emerged to identify the quality-of-life experience regarding a particular illness, such as cancer. The current step is the development of measures for specific populations in oncology. Another trend is the move from objective to subjective measures of assessment. A third trend is movement toward a multidimensional perspective, with the latest addition being the inclusion of a spiritual domain.This project explored the unique experience of cancer patients with recurrent or metastatic disease by utilizing qualitative methodology to describe common themes which emerged from the data. Focus group sessions centered around defining quality of life and discussing the factors that diminish or enhance a meaningful quality of life. A unique contribution of this study was the involvement of the participants as co-researchers in the analysis of the data. Thirteen central themes were identified: control, attitude, humor, death, gratitude, faith, fear, pain, social comparison, social support, financial concerns, information and knowledge, and the focus group experience. The findings confirmed the recent trends in quality-of-life research--multidimensionality, subjectivity, and the uniqueness of a specific cancer population, those with recurrent or metastatic disease. With this elicitative data, future research could include the development of a quality-of-life instrument for this population of oncology patients with more advanced cancer. / Department of Counseling Psychology and Guidance Services

Counselor physical attractiveness has been shown to affect subject perceptions and expectations. One characteristic which is particularly at odds with the attractiveness ideal is obesity. This study examined the potential effect of counselor obesity level on subjects' perceptions, expectations, and willingness to pursue counseling. Two hundred twenty-five students (146 women and 79 men) participated. Each subject rated one of six randomly selected counselor descriptions, including a photograph when appropriate, on the dependent measures (i.e., Counselor Rating Form-Short Version, Personal Problem Inventory, and questions rating physical attractiveness and willingness to pursue counseling). The data were analyzed using 2 (Gender of Counselor) X 3 (Obesity Level: Obese, Nonobese, Control) and 2 (Gender of Counselor) X 3 (Obesity Level) X 2 (Gender of Subject) ANOVA and MANOVA techniques, as appropriate. Male subjects perceived obese counselors to be less expert than did females. No other statistically significant differences based on Counselor Obesity Level were identified. Instead, main effects for both Gender of Counselor and Gender of Subject were obtained. Generally, the woman counselor was rated more positively than the man. Also, women subjects generally gave more positive ratings than did men. While the effects identified were statistically significant, their small effect sizes and small mean differences may limit their practical effect. Obesity level does not appear to affect how counselors are perceived or treated, particularly when they are moderately obese. / Department of Counseling Psychology and Guidance Services

The purpose of this study was to investigate the influence of gender, time since diagnosis, and the family environment on the psychosocial adaptation of cancer patients. This study was important because there is a deficit in the literature investigating the effects of the family environment on psychosocial adaptation in male and female cancer patients with diverse diagnoses. This study measured psychosocial adaptation by the patient's ability to adjust to cancer-related stressors in the areas of social relationships, involvement in health care, psychological well-being, household and work related duties, and family relationships. The family environment was measured by the patient's perceived level of cohesion, expressiveness, and conflict in the family.The study's sample consisted of 149 stage I or II cancer patients over the age of 50 with no prior cancer diagnosis, recurrence, or metastases. Participants completed a set of questionnaires, including the Psychosocial Adjustment to Illness Scale and the Family Relationship Index. The combination of gender, time since diagnosis, and the family environment, with demographic variables held constant, was significant and accounted for nearly one-third (27 %) of the variance in cancer patients' psychosocial adaptation. Results showed that the family environment is a significant predictor of psychosocial adaptation in cancer patients. Gender and time since diagnosis were not significantly related to psychosocial adaptation. Implications from this study are offered. / Department of Counseling Psychology and Guidance Services

Quality of health care delivered in the public sector remains a major challenge with diminishing resources to meet the increasing health care demands. Improvements in quality health care are identified in the Department of Health’s strategic framework as a key challenge. In order to improve quality, one needs to measure it. The patients’ views are important in identifying what is important to them. Inexpensive, easy to collect metrics need to be developed to measure quality of care. The study investigated perceptions of patients as a reflection of quality of care provided. The study also determined the key success factors in quality care in emergency departments and priorities of quality of care for improvement. A prospective study was conducted using one of Gauteng hospitals’ emergency departments as a case study. A structured questionnaire based on an overall care index focusing on specific dimensions of patients’ experience with health care was used to collect the data. Quantitative analysis was done using the Epi Info statistical package and the results summarised in frequency diagrams and tables. The findings indicate that waiting time is a major factor in perception of quality of health care. Although other hospitality issues in health care are important to patients, the degree to which they affect perception of quality of health care is difficult to determine because of the overwhelming influence of waiting time. It is recommended that priorities in addressing what users really want from health care should concentrate on strategies to shorten the waiting time. It is further recommended that a similar study be carried out in future once the waiting times have been improved considerably thus eliminating its excessive influence. This may highlight other variables important to the patients that may need to be improved in order to improve quality of care. / Dr. Susan Jennifer Armstrong

Le mode de collecte web gagne de plus en plus de popularité depuis sa création, ceci notamment en raison des avantages qu’il apporte en termes de coût et de temps. Cependant, les tendances nonprobabilistes des échantillons web font souvent douter de leur capacité à fournir des résultats aussi représentatifs que ceux d’un mode traditionnel typique tel que le téléphone. Le but de ce mémoire est de comparer les modes non-probabiliste web et probabiliste téléphone souvent suggérés par les firmes de sondage au Québec. Nous analysons principalement les éventuelles différences entre les échantillons web et téléphone du point de vue de l’adaptation à la maladie de Lyme. Plus spécifiquement, les trois objectifs de l’étude sont de : (1) comparer la représentativité des deux échantillons avec les données du recensement en termes de caractéristiques sociodémographiques, (2) comparer ces modes d’enquête en ce qui concerne l’estimation des taux d’adoption de comportements préventifs à l’égard de la maladie de Lyme tel que rapportés par les répondants aux deux sondages, et (3) tester l’invariance de la mesure des comportements préventifs des échantillons non probabiliste (panel Web) et probabiliste (téléphone). Les données proviennent d’une étude sur les comportements d’adaptation à la maladie de Lyme. Les échantillons panel Web (n=956) et téléphone (n=1003) sont constitués de résidents québécois de 18 ans et plus habitant les régions de risques faible à significatif. Les résultats montrent premièrement qu’aucun des échantillons n’est représentatif de la population cible au regard des caractéristiques sociodémographiquestelles que rapportées dans le recensement canadien de 2016. Deuxièmement, nos résultats indiquent que le taux de non-réponse aux comportements préventifs d’adaptation à la maladie et autres variables associées est significativement plus élevé dans l’échantillon web. Cependant, la magnitude de cette différence est nulle pour 19 items sur 30, et faible pour les 11 autres. De plus, aucune différence importante n’a été relevée lors de la comparaison des deux échantillons du point de vue de l’estimation de la prévalence desdits comportements et leurs déterminants. Enfin, les analyses d’invariance de l’indice d’adaptation ou de prévention à l’égard de la maladie de Lyme révèle que la structure de l’indice est la même pour les deux échantillons. On en conclut que malgré certaines différences observées entre les modes web et téléphone, les répondants des deux échantillons ont tendance à adopter des comportements similaires d’adaptation à la maladie de Lyme. / The web data collection mode has been increasing in popularity since its creation, primarily due to its cost and time effective benefits. However, its non-probabilistic tendencies often bring doubts concerning the representativity of its results in comparison to a typical mode such as the telephone. This master’s thesis compares the non-probability web and probability telephone modes, often suggested by polling firms in the province of Quebec. It principally analyzes the eventual differences between both samples on their adaptation to the Lyme disease. More specifically, the three main goals of this study are: (1) to compare the representativeness of both samples with the census data in terms of their socio-demographic characteristics, (2) to compare those two survey modes regarding their respondents’ preventive behaviour estimates against the Lyme disease, and (3) to test the measurement invariance of the nonprobability (Web panel) and probability (telephone) samples’ preventive behaviour. The data comes from a study on the adaptation of prevention behaviors against Lyme disease. The web (n=956) and telephone samples (n=1003) are made of individuals, 18 years old and above, from low and significant risk regions. Results firstly reveal that neither survey is representative of the Canadian census of 2016. Secondly, results show that the non-response rate for Lyme disease prevention adaptive behaviors and other associated variables is higher in the web survey. However, the magnitude of this significance is nil for 19 out of 30 the items, and small for the other 11. Moreover, no important dissimilarities were found in comparing both samples’ estimates in terms of the behaviours’ prevalence and their determinants. Finally, the measurement invariance analyses on the index of adaptation to the Lyme disease show a similar structure of the index for both samples. In conclusion, although the web and telephone samples are different in some respects, their respondents tend to have similar behaviors of adaptation to the disease.

Les symptômes comportementaux et psychologiques de la démence (SCPD) provoquent des conséquences néfastes pour l’aîné, ses proches, les autres usagers et les soignants. Le but de cette étude rétrospective est de décrire la prise en charge des SCPD par des infirmières. L’étude s’appuie sur le modèle infirmier sur les besoins compromis d’Algase. Les résultats issus des données de 38 dossiers démontrent que la pratique des infirmières de l’équipe de mentorat du Centre d’excellence sur le vieillissement de Québec atteint un niveau de concordance élevé avec les recommandations des lignes directrices sur les SCPD. Par ailleurs, les interventions proposées par ces infirmières réduisent de façon significative la fréquence et la gravité des SCPD. De plus, le niveau de satisfaction des soignants et des proches est élevé. Enfin, les conclusions de cette étude soutiennent les propositions d’Algase qui suggère d’intervenir sur les causes sous-jacentes des SCPD afin d’en diminuer la survenue. / Behavioural and psychological symptoms of dementia (BPSD) lead to adverse consequences for older adults, their families, fellow residents and caregivers. This retrospective study proposed to describe nurses’ management of BPSD, using Algase's need-driven dementia-compromised (NDB) nursing model. Data from 38 file reviews demonstrated that the nurse practice of the mentoring team from Quebec's Center for Excellence in Aging achieved a high level of agreement with guideline recommendations for BPSD. Moreover, interventions by these nurses lowered the frequency and severity of BPSD significantly and in addition, the level of satisfaction among the caregivers and families was high. Finally, the findings of this study support Algase's proposals that nurses deal with the underlying causes of BPSD in order to lower its occurrence.

Dans les pays industrialisés, les maux de dos représentent un problème majeur de santé publique dont les répercussions socioéconomiques prennent des proportions démesurées. L'essentiel de ce fardeau économique serait attribuable à l'état d'incapacité prolongée affectant une minorité d'individus. L'objectif principal de cette étude était d'évaluer l'importance de deux construits liés au contrôle, le sentiment d'efficacité personnelle et le lieu de contrôle de la santé, chez 1007 travailleurs ayant consulté dans un milieu de première ligne pour un mal de dos, pour expliquer leur statut fonctionnel et occupationnel deux ans après la consultation initiale. Cette étude prospective s'appuyait sur la théorie du sentiment d'efficacité personnelle de Bandura. Une méthodologie quantitative a été utilisée. Les analyses ont révélé que le sentiment d'efficacité personnelle est un facteur protecteur d'une évolution défavorable chez ces individus (RC : 0,19 ; IC 95% : 0,07-0,48). Ces résultats supportent le besoin de développer de nouvelles stratégies d'intervention auprès de cette population.

La polyarthrite rhumatoïde est une maladie auto-immune qui affecte environ 1% des Canadiens. En raison des symptômes de douleur et de fatigue, les patients arthritiques sont moins actifs et plus sédentaires que la population générale. L'activité physique est bénéfique pour réduire le risque de morbidité et de mortalité. L'objectif de ce projet de maîtrise était d'explorer les différences entre deux types d'intervention en exercice, soit une intervention supervisée et une intervention à domicile, sur l'adhérence des patients. Les patients, quatre hommes et onze femmes, étaient soumis à une intervention d'exercice d'une durée de 12 semaines. Les patients dans l'intervention supervisée devaient s'entraîner à raison de 3 fois par semaine, pour une durée de 60 min, dans un centre de réadaptation sous la supervision directe d'un kinésiologue. Les patients dans l'intervention à domicile devaient s'entraîner 5 fois par semaine, pour une durée de 30 minutes continues, à la maison. Un suivi était fait à 24 semaines dans lequel les patients avaient la consigne de demeurer actifs. Des mesures de la condition physique, soit la capacité cardiorespiratoire ainsi que les mesures anthropométriques et la capacité fonctionnelle, étaient réalisées pour s'assurer de l'efficacité des deux interventions. Les résultats démontrent que l'adhérence à l'intervention supervisée est légèrement supérieure à l'intervention à domicile (95,2% vs. 82,9%; p=0,04). Toutefois, les deux interventions sont faisables et sécuritaires. / Rheumatoid arthritis (RA) is an auto-immune disease that affects 1% of Canadians. As pain and fatigue are the main symptoms, patients with RA are less active and have more sedentary behavior than healthy people. It is known that exercise is effective to reduce morbidity and mortality. The goal of this master's degree project was to assess the difference between a supervised and a home-based exercise intervention. Patients, four men and eleven women, were randomized into either the supervised group or the home-based group and had to do a 12-week exercise program. Follow-up was at 24 weeks in which patients were instructed to stay active. Measures of cardiorespiratory fitness, anthropometric and body composition measures and functional capacity were assessed during the entirety of the study. Results show that the supervised intervention is slightly superior in maintaining adherence than the home-based intervention although both interventions are feasible and safe.

Thesis (MPhil (Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy. Centre for Rehabilitation Studies))--University of Stellenbosch, 2007. / Current emphasis for rehabilitation in South Africa remains on individual intervention within the move towards primary health care. Primary health care is the strategy that has been adopted by the South African department of health to bring access and equity in health care services. Even so, the burden of providing effective rehabilitative services with limited resources requires innovative strategies, such as the use of therapeutic groups, to address certain aspects of rehabilitation. These strategies must be proven effective. There is a paucity of literature detailing the uses of group therapy in physical rehabilitation, and particularly the use of interdisciplinary group work in stroke rehabilitation. Furthermore, evidence shows that stroke survivors feel ill equipped to return to their communities despite rehabilitation. Stroke is a major cause of death and disability in South Africa, and is a condition shown to benefit from rehabilitation. These factors led to the selection of the Bishop Lavis Rehabilitation Centre stroke group as the setting for this study, which aims to describe the range of experiences relating to attendance or non-attendance of those referred to this programme. This descriptive study, employing quantitative means (to describe the demographic details of the participants) and qualitative means (to describe the experiences of participants), was conducted with twenty participants. Data was collected by means of an administered questionnaire. Following that, a focus group discussion involving six participants was used to gather in-depth information. Quantitative data was analysed with the assistance of a statistician, utilising the computer program, Statistica. The Chi-Squared, Kruskal-Wallis and ANOVA tests were used, with p>0.05 showing statistical significance. Qualitative data was thematically analysed, whereby data was categorised by means of an inductive approach. The study population consisted of 20 participants, with an average age of 59 years, of whom 15 were female and five male. The stroke group provided meaning to participants on two levels. On a psychosocial level, the phenomena of universality (identifying with others in a similar position), development of socialising techniques, imparting information and cohesiveness emerged strongly. On the level of meaning related to stroke recovery, improvement in ability to execute activities of daily living, mobility and strength were most frequently mentioned. Transportation issues were most commonly mentioned as factors negatively influencing attendance. Staff attitude and activities of the programme were most often cited as positive factors. Given the positive response of study participants, and the programme’s ability to sustain intervention with limited resources, it was concluded that this programme has a valid place within stroke rehabilitation in Bishop Lavis. Recommendations in terms of the group programme included investigating methods of providing transportation, providing childcare facilities and expanding the content of educational sessions. Further recommendations were to maintain the positive attitude of staff and the current activities of the programme. Frequency of group outings should also be increased and compensatory strategies for inclement weather must be explored.